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Wednesday, January 27, 2021
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Dosing advances in photobiomodulation (laser therapy)

Gaining a better understanding of the advancements in photobiomodulation can help you maximize the benefits of this technology in a veterinary clinic setting.

The positive effects of photobiomodulation therapy (formerly low level laser therapy, or LLLT) were originally observed in a rodent model more than 60 years ago by Dr. Endre Mester when he noted the effects this application of light had on hair growth and wound healing. Since that time, further research has expanded our understanding of PBM and the particulars of “dosing light” for a variety of conditions, not just in cell culture but extrapolated to take into account light-tissue interactions in living beings. With this expanded understanding we may better utilize this exciting technology in veterinary medicine to treat our patients, particularly those with pain or conditions mediated by inflammation.

The PBM-cellular relationship

Many scientific studies have been conducted in vitro to characterize the amount of light needed to create a response on a cellular level. The challenge, from a physics standpoint, has always been being able to target tissues in vivo at depth. The “right” amount of energy needs to reach the specific “target” tissue in order to have an effect – whether that is nervous tissue, bone, other soft tissue structures, etc. Cells and tissues can be directly stimulated by and become responsive to PBM in this way. However, it has also become clear that some cells are “bystanders” in this process, benefitting based on their proximity to their neighbors in the tissues, or only after other cells, stimulated by PBM, produce the requisite growth factors or substrates necessary to jumpstart their cellular machinery. But what are the “right” parameters?

Defining the parameters

When clinically we began treating patients with PBM years ago, parameters taken from cell culture studies were used. While these often resulted in positive clinical outcomes for things like wound healing or superficial dermatologic lesions, results were often inconsistent for deeper tissue conditions. Recognizing that inconsistent or negative results may have been due to underdosing in vivo due to the way that light and tissues interact (especially as regards light losses) led to research and clinical treatment advancements that have benefitted veterinary and human patients alike. The wide range of factors that contribute to positive or negative outcomes for various conditions in vivo include things like the types and thickness of the tissue being treated, the wavelength(s) of light being used, the total amount of energy delivered and the time course over which that delivery takes place. More recent research has also elucidated that it is not just the total amount of energy that is important, but also the energy density, or fluence (measured in J/cm2) applied to the tissue as well as the power density (irradiance, or W/cm2) at which the light is applied to the tissues. It should be noted, that published studies using PBM often do not report, or inaccurately report, the parameters listed above and therefore a closer examination of the dosimetry used in a study should be undertaken before drawing conclusions about the relevance of the results.

Technological advancements: learning to adapt

To address some of the dosing considerations mentioned, the use of advanced laser devices utilizing higher power and specialized software that take coat length, coat color, skin color as well as body type into account may allow clinicians to safely apply more intense doses of light at the skin surface. This not only allows them to achieve adequate total doses of light for deep tissue conditions (such as pain) but also allows treatment within a more efficient time frame compared to older, lower power laser devices. Additionally, automatic protocols, written by manufacturers should take into account the latest research when designing treatments for various conditions. All laser users should have a comprehensive understanding of how to safely and effectively adjust doses for their patients as individuals, understanding that automatic protocols may serve as a general guide and that questions should be asked of laser manufacturers regarding protocol design and dosimetry as well as best practices for application (on vs. off-contact application).

It is necessary to take all of these variables into consideration and to understand their importance when determining why a treatment may or may not have been successful or why there may be variability between published study results and our own clinical outcomes. The use of larger beams of light or specialized real-time feedback in software are emerging as strategies that aid in the delivery of the desired amounts of light energy to the desired target tissues. Careful attention to parameters is important. Despite our desire to simplify, there is no singular simple answer for light dosing and tissue penetration to achieve optimal outcomes for PBM. Through further research and the continued advancement of PBM devices, we will only continue to advance patient care in veterinary medicine.

References

  1. Mester, B. Szende, and P. Gartner, “The effect of laser beams on the growth of hair in mice,” Radiobiol. Radiother. (Berl) 9(5), 621–626 (1968).
  2. Lanzafame, “Light Dosing and Tissue Penetration: It Is Complicated.” Photobiomodulation, Photomedicine, and Laser Surgery. 38(7), 393-394 (2020).
  3. Anders, H. Moges, X. Wu, et al., “In vitro and in vivo optimization of infrared laser treatment for injured peripheral nerves.” Lasers Surg Med. 46(1), 34-45 (2014).
  4. Zein, W. Selting, M. Hamblin, “Review of light parameters and photobiomodulation efficacy: dive into complexity” J. Biomed. Opt. 23(12), 120901 (2018).
  5. Lanzafame, “Photobiomodulation, tissue effects and bystanders.” Photomed Laser Surg. 29:519–520 (2011).

Tips for boosting clinic revenue through curated supplement offerings

Pet supplement sales are booming amid the pandemic, making them an excellent stream of revenue in veterinary clinics.

The COVID-19 pandemic has brought about many changes to the way you interact with your clients and the measures you must take to ensure the health and safety of all who enter your practice. It hasn’t been easy, but you’ve made it work by being flexible and putting one foot in front of the other.

One surprising outcome that could benefit your practice has been the increased focus pet parents have placed on their own health and wellness, and that of their pets. We’ve known all along that pet parents who use human dietary supplements for themselves are more likely to turn to pet supplements to proactively support a pet’s health. But in 2020, a staggering 21% increase in pet supplement sales1 showed us pet parents are serious.

The veterinary channel accounts for 46% of this increase1, which could signal an opportunity for you to boost revenue by offering a curated selection of quality supplements your medical team feels good about and that offers you a reasonable margin. But keep in mind that your pricing must be competitive with online sellers. You differentiate yourself through the services you provide, client education and real-time answers to pet parents’ questions. But if you price supplements too high you risk losing the sale and possibly a client.

In terms of what to stock, the COVID-19 era has seen pet parents placing emphasis on products that support immune health and overall wellness:

  • Daily multivitamin supplements can help fill in nutritional gaps and provide overall support.
  • Antioxidant supplements can help to neutralize harmful free radicals and protect cell health.
  • Digestive support supplements containing digestive enzymes, probiotics and prebiotics can support a healthy gut microbiome, which is essential to overall wellness and maintaining a strong immune system.
  • Calming supplements are another area of opportunity, as many people have adopted “pandemic pets” and need support as these companions adjust to their new home environment, or as pet parents return to the workplace and leave pets home alone for the first time in a year.
  • Joint health supplements are always a strong performer and can be recommended throughout all the life stages to support pets as they age.

Focus on the categories mentioned above, as well as those most often asked about or requested by your clients and be sure to offer several delivery formats—a tablet for dogs that will eat anything, powder that can be easily hidden in a finicky cat’s food, soft chews for small pets, etc.

Finally, make quality a priority when selecting products to recommend. Look closely at the supplier’s website and marketing materials, keeping in mind that supplements aren’t magic bullets and if claims sound too good to be true, they probably are. Remember that responsible manufacturing costs money and cheap products are probably cheap for a reason. Focus on selecting products with the NASC Quality Seal, as this will help to ensure you are choosing suppliers that responsibly produce and market their products and maintain ongoing compliance with the National Animal Supplement Council’s rigorous quality standards. To see a list of suppliers that have earned the Quality Seal, visit nasc.cc/members.

1 Source: Pet Supplements in the U.S., 8th Edition, Packaged Facts, January 2021

Rapid point-of-care diagnostics in animal hospitals

Veterinary medicine has a significant need for in-clinic point-of-care (POC) tests that can deliver rapid, reference lab-quality sensitivity and specificity data. 

In the veterinary clinic setting, rapid point-of-care tests allow for accurate insights to be derived from the results, so clinicians have more confidence in their prescribed treatment plans. Furthermore, the rapid nature of this type of testing lends itself to producing results in real time, possibly while the patient is still in the hospital, removing the impact of time delays experienced with traditional reference laboratory testing methods. These innovations are on the cutting edge of both veterinary and human diagnostics.

The need for faster results

In veterinary medicine, clinicians rely on available diagnostic technologies to confirm diagnoses and provide clinical insight into patient care. In the case of suspected bacterial infections, culture and susceptibility (C&S) tests are routinely ordered to provide definitive insight into the causative pathogens, and to determine whether antimicrobial resistance is present. Commonly, however, the need to make treatment decisions often precedes obtainment of the C&S results, requiring antibiotics to be prescribed empirically in order to address the suspected infection, improve the patient’s symptoms, and to give the client peace of mind that their pet has been offered solutions-focused patient care. Once the C&S results are received, the empiric antibiotic selection is either confirmed as effective, or if resistance is demonstrated, the antibiotic is changed.

When culture testing is ordered, the collected samples are typically shipped to centralized reference laboratories for C&S testing. The downside of these current testing methods is the time delay involved in shipping samples offsite, in addition to laboratory processing times. The standard turnaround time for C&S testing is three to five days, with some cases taking up to one week or longer for certain infection types, or in the case of practices located in rural areas that may be some distance away from testing facilities.

Urinary symptoms, such as straining to urinate and blood in the urine, are common reasons for dogs and cats to be taken to the emergency room, with urinary tract infections (UTIs) often being one of the top differentials. A previous study evaluating the prevalence of UTIs diagnosed via C&S demonstrated that 17.5% of cases were positive for at least one bacterial isolate.[1] Some of these results could be false negatives; however, the negative samples could also indicate an underlying non-infectious pathology, such as bladder stones or cancer. For some of these disease conditions, the long turnaround time for C&S testing could potentially delay the pursuit of further diagnostics, and achieving a definitive diagnosis, thereby delaying the start of effective treatment for the patient.

Promising results from early clinical trials

Ethos Veterinary Health is a network of 25 emergency and specialty hospitals located across the US, with significant experience in conducting veterinary clinical trials. Ethos has been working with the molecular diagnostics provider LexaGene to help quickly advance this emerging technology through the development of an in-house PCR analyzer capable of providing accurate infectious disease testing with a rapid turnaround time. In June 2019, Ethos launched the first beta trial of LexaGene’s automated PCR analyzer for the detection of urinary tract infections. This trial demonstrated 98.2% concordance between the analyzer results and standard C&S testing. LexaGene and Ethos now seek to conduct further clinical trials for other disease indications, including infectious disease, inflammatory disease, and cancer.

Antimicrobial stewardship

The use of POC molecular testing allows for the improved implementation of antimicrobial stewardship programs that encourage the judicious use of antimicrobials to reduce antimicrobial resistance rates. The focus on antimicrobial resistance to date has been predominantly to measure its impact on human health; however, there is now an increasing focus on veterinarians to adopt a One Health[2] approach in veterinary medicine in an effort to curb the development of antimicrobial resistant bacteria. Studies in human healthcare have shown that antimicrobial resistance, especially multidrug resistant infections, significantly impact the ability of practitioners to properly treat infections – a risk that has been described as one of the greatest threats to human health worldwide.[3] Antimicrobial resistance in veterinary patients presents similar treatment challenges for veterinarians and has the potential to transfer this bacterial resistance to humans, which is of particular concern to government, industry, academia, and veterinary organizations who play an active role in the stewardship of antimicrobials used in animals.[4] By providing insight into causative pathogens and antibiotic resistance factors, PCR testing can facilitate the use of first-line antibiotics that will reasonably treat the infection and mitigate the temptation for veterinary practitioners to prescribe higher tier antibiotics in treatment, which would represent a divergence from good antibiotic stewardship practices.

Improved care for complex infections

In addition to antimicrobial stewardship, POC molecular diagnostics could also improve the diagnostic and treatment process in patients with chronic, recurrent, or complicated infections. These patients can often have more complex infections with multiple pathogens, each potentially with a different antimicrobial susceptibility profile. Furthermore, traditional culturing techniques might not always be representative of the full spectrum of pathogens that are present at the site of infection. With these patients being at a higher risk for multidrug resistant infections, there is a higher possibility that they could be started on an ineffective antibiotic pending their C&S testing results. These patients, even more so than those with simple infections, would likely benefit the most from a rapid POC test, especially in the setting of severe infections where a delay in effective treatment could result in progression to sepsis and a significantly higher mortality risk.

Transitioning to molecular-based POC testing

The use of molecular-based POC tests is a novel diagnostic approach in veterinary medicine and is not a typical component of the standard diagnostic workflow. Since the empirical prescription of antibiotic treatment is so prevalent in the face of long turnaround times for test results, there may be a reluctance among practitioners to depart from a known treatment practice and financial model. However, as the development of molecular diagnostics progresses in veterinary medicine, and are demonstrated to have acceptable accuracy, it is expected that their use will eventually become more commonplace. Furthermore, there is significant ongoing research in molecular diagnostics in both human and veterinary medicine, opening the door for a wide range of disease applications that this technology can be used for.

Ethos Veterinary Health plans to incorporate molecular-based POC testing at its locations to rapidly triage infections as an innovative approach to patient care and adoption of cutting-edge veterinary medicine technology. LexaGene launched its MiQLab™ system – an automated, easy-to-use PCR analyzer for point-of-care testing – in the fall of 2020.  For further information, visit ethosvet.com and lexagene.com.

Disclosure: The work expressed in this article is from Dr. Stewart’s research experience with LexaGene and its technology through his role at Ethos Veterinary Health. _________________________________________________________________

1Hall JL, Holmes MA, Baines SJ. “Prevalence and antimicrobial resistance of canine urinary tract pathogens”. Vet Rec. 2013;173(22):549.

2One Health-AVMA. Available at: https://www.avma.org/resources-tools/one-health.

3Llor C, Bjerrum L. “Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem”. Ther Adv Drug Saf. 2014;5(6):229-241.

4“Supporting antimicrobial stewardship in veterinary settings: goals for fiscal years 2019-2023 — FDA Center for Veterinary Medicine”. Available at: https://www.fda.gov/media/115776/download.

Why fish oil has an important role in targeted nutritional therapy for cancer patients 

High quality fish oil is generally regarded as safe and helpful for supporting general health. But what about its use specifically for cancer patients? Current research supports promising findings for targeted therapy.

Dogs must obtain essential fatty acids through food, and while many canine diets contain an abundance of omega-6 fatty acids, omega-3 fatty acids require a little more nutritional attention. Dogs can synthesize the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from alpha-linolenic acid (ALA), an omega-3 fatty acid found in plant and nut oils, but the process is not efficient enough for therapeutic use. As a result, EPA and DHA must then be supplemented, for example, from marine-sourced lipids.

EPA and DHA found in fish oil are commonly recommended supplements to support skin, coat, and joint health in companion animals. They are one of the most studied supplements in both human and veterinary medicine. And research shows they can improve immune function, mediate inflammation, and balance hormones, as well as enhance both cognition and neuromuscular function.

There is also a growing body of research to support their targeted therapeutic use in cancer patients.

Mitigating muscle atrophy and cancer cachexia

Cancer cachexia is defined as rapid, involuntary loss of muscle mass and is generally associated with a poor prognosis and a reduction in quality of life. Pro-inflammatory factors, tumoral factors, inappetence and subsequent lack of energy and nutrient intake, physical inactivity, and side effects from cancer treatments or surgery all contribute to the multifactorial process of cancer cachexia and muscle atrophy.

Two review studies demonstrate a promising area of therapeutic intervention using omega-3 fatty acids to support muscle anabolism in the cancer state. Research shows that EPA and DHA are incorporated into the membrane phospholipids of both the sarcolemma and intracellular organelles of skeletal muscle cells, helping to preserve skeletal muscle function by reducing loss of muscle mass and by preventing dips in mitochondrial respiration during prolonged periods of inactivity. The EPA and DHA-enriched membranes are associated with increased synthesis of muscle protein and decreased expression of factors regulating breakdown of muscle protein (1,2). While further studies are needed to identify the exact molecular mechanisms of these effects, using EPA and DHA for targeted nutritional therapy in the cancer patient offers a promising avenue of intervention to combat cancer cachexia.

Anti-neoplastic activity

EFAs are also being studied for their specific anti-neoplastic effects, in addition to their roles in decreasing overall inflammation and enhancing quality of life. Research indicates that they can induce apoptosis of neoplastic cells alone (through selective toxicity to cancer cells and not normal cells) or in combination with conventional therapies (enhancing the response to chemotherapeutics). There is also the potential for EFAs to reduce toxicity from the chemotherapeutic agents themselves (3).

High quality fish oils from sustainable wild sources that are pure and free from PCBs, heavy metals, toxins, and other contaminants offer many benefits for not only overall health and well-being, but for targeted nutritional therapy for veterinary cancer patients as well. They should be considered an important part of an overall nutrition system designed for any canine with a cancer diagnosis.

References

  1. McGlory C, Calder PC, Nunes EA. The influence of omega-3 fatty acids on skeletal muscle protein turnover in health, disuse, and disease. Front Nutr. 2019;6:144.
  2. Malta, F, Estadella D, Goncalves D. The role of omega-3 fatty acids in suppressing muscle protein catabolism: a possible therapeutic strategy to reverse cancer cachexia? Journal of Functional Foods. 2019;54:1-12.
  3. Laviano A, Rianda S, Molfino A, Rossi Fanelli F. Omega-3 fatty acids in cancer. Curr Opin Clin Nutr Metab Care. 2013;16(2):156‐161.

New formula shows promise as a treatment option for oral dysbiosis in cats

A unique new formula known as Protektin30™ may offer an effective solution for oral dysbiosis in feline patients.

Oral dysbiosis, an imbalance of the microbial community that inhabits the oral cavity is more well-studied in humans and dogs but evidence suggests that dysbiosis also correlates with feline chronic gingivitis and gingivostomatitis (FGS).1,9 FGS is a chronic inflammatory disease characterized by mucosal inflammation and swelling of the gingiva, causing pain and abnormal chewing/feeding behavior.8

Diagnosis

A hallmark of oral dysbiosis is the loss of microbial diversity within the oral cavity. In lower GI and skin microbiome research, loss of diversity strongly correlates with an increase in inflammation.2,3 Recent work has characterized the in situ inflammatory responses driven by a dysbiotic microbiome. Briefly, it has been shown to elicit characteristic Th17/Th23 immune responses, including increases in IL-6 and IL-23 cytokine levels and an accumulation of neutrophil invasion the affected gingival tissue.7  This can then lead to gingival swelling, stimulation of gingival nerves surrounding the periodontal ligament and inappropriate growth factor expression.10,11

A second hallmark of oral dysbiosis is the increased presence (burden) of pathogenic microbes, such as Porphyromonas sp., Tannerella sp., Treponema sp., and/or abnormally high levels of commensal microbes such as Fretibacterium sp., Peptostreptococcus sp., and Catonella sp.4-6,12

A third hallmark of oral dysbiosis is the loss of or significant decreased presence of beneficial microbes known to be protective (they either regulate healthy immune balance or promote healthy barrier functions). Less is known about the feline oral microbiome, but several groups (ourselves included) are focused on their identification and characterization.

Considering the cause

The most significant driver for the development of oral dysbiosis in feline is diet. Age, exercise, exposure to antibiotics, some medications, and an alteration of the cat’s health (particularly having to do with salivary output and liver function) have also been linked.

A targeted treatment approach

We developed an approach to rehabilitate a dysbiotic oral microbiome in felines. Briefly, an ideal approach would be safe and well-tolerated for daily consumption, work directly on the oral microbiome upon contact, and induce changes in the composition of the oral microbiome in a relatively short period of time.

After screening hundreds of GRAS (generally recognized as safe) ingredients with ideal safety profiles for daily consumption in felines, we identified several target ingredients that selectively (i) blocked the growth of pathogenic bacteria and fungus in the oral cavity, (ii) but induced the growth of beneficial microbes in co-culture and in oral biofilm studies.

Formulation studies showed a synergism when used in combination that were ideal for use in feline, particularly when administered in drinking water. This synergistic combination of ingredients is called Protektin30™ and has been tested in over 198 oral biofilm cultures showing significant ability to reduce the growth of harmful species such as Catonella sp., Peptostreptococcus sp., Porphyromonas sp., Staphylococcus sp. and enables persistence of more balanced levels of commensals that are often found in healthy felines. Protektin30™ will be undergoing placebo-controlled clinical evaluation in 2021. More can be found at teefhealth.com.

References

1https://pubmed.ncbi.nlm.nih.gov/10391845/

2https://academic.oup.com/ibdjournal/article/13/6/675/4644945

3https://link.springer.com/article/10.1007/s40257-020-00531-1

4https://iai.asm.org/content/68/6/3140

5https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129341/

6https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366302/

7https://stm.sciencemag.org/content/10/463/eaat0797?intcmp=trendmd-stm

8https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.14850

9https://pubmed.ncbi.nlm.nih.gov/12585597/

10https://www.tandfonline.com/doi/abs/10.1080/000163500429226

11https://www.tandfonline.com/doi/full/10.1080/20002297.2017.1334503

12https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297541/

Vaccination in adult dogs and cats: what do we need to consider?

Vaccines should be thought of as any other medication, and used as necessary to address the true health needs of each canine and feline patient, especially when they become adults. Both the core and non-core revaccination needs of adult dogs and cats should take into account the individual’s risk of exposure, along with geographical location, and lifestyle factors.

A more proactive approach is still needed to both standardize the production and individualize the use of veterinary vaccines to ensure their safety and efficacy. This is especially relevant for dogs and cats who have been properly vaccinated and immunized as youngsters. This article explores factors to consider when creating vaccination strategies for adult animals.

Why a new approach?

Controversies and misunderstandings around the principles of immune memory and protection are ongoing. In addition, compliance failure with current national vaccine policies and guidelines, resistance to change, and denial of the potential for adverse events within the general veterinary community and society as a whole complicate thoughtful vaccine decisions for adult companion animals.

The solution depends upon more focused educational efforts within academic veterinary medicine, clinical practice, and companion animal owner communities. Vaccines are not innocuous products; the benefit/risk equation needs to be assessed before vaccination and booster vaccination.

No panacea

There is little doubt that the application of modern vaccine technology has permitted us to effectively protect companion animals (and people) against serious infectious diseases.1-5 However, vaccinations are increasingly recognized (albeit still rarely) as contributors to immune-mediated blood, skin, bowel, bone, and joint diseases, bone marrow and organ failure, central nervous system excitation, and behavioral aberrations.3,6 Genetic predisposition to these adverse events (termed vaccinosis) has been documented. It must be recognized, however, that we have the luxury of expressing these concerns today only because the risk of disease has been effectively reduced by the widespread use of vaccination programs. Nevertheless, the accumulated evidence indicates that vaccination protocols should no longer be considered a “one size fits all” program.1-3,7,8

In cats, while adverse vaccine reactions may be less commonly seen, aggressive tumors (fibrosarcomas) can occasionally arise at the site of vaccination, as they can in dogs.8,9 Other cancers, such as leukemia, have been also been associated with vaccines.9 In the ensuing 20 years since vaccine-associated sarcomas were recognized in cats, the prevalence has not decreased nor has the age of affected cats increased, despite changes in vaccine formulations and worldwide protocol guidelines.9

Even today, it is estimated that only 40% of veterinarians are following the current World Small Animal Veterinary Association, American Veterinary Medical Association, American Animal Hospital Association, and British Veterinary Association vaccine policy guidelines.3 There is no such thing as an “up to date” or “due” vaccination. Enlightened veterinarians can now offer a package of separated vaccine components, when available, rather than administer them together, since the published data show more adverse reactions when multiple vaccines are administered concurrently.

Vaccine dosage

Dogs are currently vaccinated with the same quantity of vaccine, independent of size or breed.1,2 Why do very small and very large dogs need the same dose of vaccines, when clinical trials by vaccine manufacturers are typically performed on laboratory beagles and with minimal field testing in different breeds prior to licensing?3 More vaccine adverse events have been documented in smaller dogs.2 Toy and small dogs logically should require less vaccine than giant and large dogs in order to be fully immunized. Similarly, puppies and kittens should require less vaccine volume to immunize than adults do.1

In support of the size hypothesis, this author studied healthy, adult, small breed dogs who had not been vaccinated for at least three years.10 The dogs were given a half-dose of bivalent distemper and parvovirus vaccine, whereby all of them developed increased and sustained serum vaccine antibody titers.10 Presumably, this approach would apply also to puppies, and further research is needed.

Vaccinate wisely, only when needed

When an adequate immune memory has already been established, there is little reason to administer booster vaccines, and it would be unwise to introduce unnecessary antigen, adjuvant, and other excipients, as well as preservatives, by doing so.3-5 Serum antibody titers can be measured triennially or more often if needed, to assess whether a given animal’s humoral immune response has fallen below levels of adequate immune memory. In that event, an appropriate vaccine booster can be administered. For legally required rabies vaccines, these alternative options are often limited by necessity, given the exposure risk to this fatal disease.11

Importantly, pet caregivers should understand that the act of giving a vaccine may not equate to immunization. Vaccines may not always produce the needed or desired immune protective response. This can occur if the vaccine itself was inadequately prepared (very rare) but also if the pet is a genetic low- or non-responder to that vaccine (quite common in certain breeds of dogs and their families, such as Akitas, Greyhounds, and Labrador Retrievers, especially black Labs). In the latter case, that pet will be susceptible lifelong to the disease of concern and revaccination will not help and could even be harmful.3,7

Vaccination can provide an immune response that is similar in duration to that which follows a natural infection. In general, adaptive immunity to viruses develops earliest and is highly effective. Such antiviral immune responses often result in the development of sterile immunity and the duration of immunity (DOI) is often lifelong.3,7,10 In contrast, adaptive immunity to bacteria, fungi, or parasites develops more slowly. The DOI is generally short compared with most systemic viral infections. Sterile immunity to these infectious agents is less commonly engendered.

Old dogs and cats rarely die from vaccine-preventable infectious disease, especially when they have been vaccinated and immunized as young adults (i.e. between 16 weeks and one year of age).7,10 However, young animals do die, often because vaccines were either not given or not given at an appropriate age (e.g. too early in life in the presence of maternally-derived antibody).1-3

More animals need to be vaccinated to achieve the 70% or more needed to increase herd (population) immunity to protect the unvaccinated against these diseases.2,8 Titers do not distinguish between immunity generated by vaccination and/or exposure to the disease, although the magnitude of immunity produced just by vaccination is usually lower.

Core vaccines should be given to all adults, but not more often than every three years, and we prefer to measure serum antibody titers instead.1-3,7 Serological and challenge studies actually indicate that protection is likely much longer, ranging from seven to nine years.7

Other issues with over-vaccination

Increased costs in time and dollars need to be considered, despite the well-intentioned solicitation of clients for pets to receive their wellness examinations.1,3 Giving unnecessary annual boosters has the client paying for services that are likely of little benefit to the pet’s existing level of protection against these infectious diseases. It also increases the risk of adverse reactions from the repeated exposure to foreign substances.1-4

Compliance or resistance to current vaccine guidelines

The issues discussed above have been legitimately raised for over two decades, but why is this knowledge still considered controversial?1-3,8 Have veterinarians embraced the national and international policies on vaccination guidelines? Does the public trust veterinarians to be up-to-date on these issues? Do they believe veterinarians have a conflict of interest if they derive income from annual booster vaccinations? While some veterinarians still tell their clients there is no scientific evidence linking vaccinations with adverse effects and serious illness, this fallacy confuses an impressionable client.3 On the other hand, vaccine and anti-vaccine zealots abound with hysteria and misinformation. Neither of these polarized views is helpful.

Veterinary practitioners may simply believe what they originally learned about vaccines and are therefore less inclined to change or “fix” what is perceived to be unbroken.1-3,8 Annual vaccination has been the single most important reason why the majority of people bring their dogs and cats for an annual check-up or “wellness visit”.  When combined with a failure to understand the principles of vaccinal immunity, it is not surprising that attempts to change vaccines and vaccination programs have created significant controversy.

As stated by the American Animal Hospital Association’s 2003 guidelines: “No vaccine is always safe, no vaccine is always protective, and no vaccine is always indicated. Misunderstanding, misinformation, and the conservative nature of our profession have largely slowed adoption of protocols advocating decreased frequency of vaccination. Immunological memory provides durations of immunity for core infectious diseases that far exceed the traditional recommendations for annual vaccination. This is supported by a growing body of veterinary information as well as well-developed epidemiological vigilance in human medicine that indicates immunity induced by vaccination is extremely long lasting and, in most cases, lifelong.”1-3 These statements were groundbreaking at the time, and still apply today.3

Vaccines should be individualized to each patient

“Vaccination should be just one part of a holistic preventive healthcare program for pets that is most simply delivered within the framework of an annual health check consultation,” said the late Professor Michael J. Day. “Vaccination is an act of veterinary science that should be considered as individualized medicine, tailored for the needs of the individual pet, and delivered as one part of a preventive medicine program in an annual health check visit.”1 

______________________________________________________________________________

1Day M J, Horzinek MC, Schultz R D, Squires R. “WSAVA Guidelines for the vaccination of dogs and cats”. J  Sm Anim  Pract  2016; 57: E1-E45.

2American Animal Hospital Association (AAHA). Canine Vaccination Task Force: Ford RB, Larson LJ, Schultz RD, Welborn LV. “2017 AAHA canine vaccination guidelines”. J Am Anim Hosp Assoc 2017; October: 26-35.

3Dodds WJ. “Vaccine issues and the World Small Animal Veterinary Association (WSAVA) Guidelines (2015-2017).”  Israel J Vet Med 2018; 73 (2): 3-10.

4Dodds WJ, Herman K. “Heavy Metals in vaccines”. J Am Hol Vet Med Assoc 2019; 57: Winter 16-18.

5Dodds WJ. “Adjuvants and additives in human and animal vaccines”. Med Res Arch. 2016; 2(5): 1-8.

6Dodds WJ. “Rabies virus protection issues and therapy”. Global Vaccines Immunol. 2016; 1: 51-54.

7Schultz RDThiel BMukhtar ESharp PLarson LJ. “Age and long-term protective immunity in dogs and cats”. J Comp Pathol. 2010; Jan;142 Suppl 1: S102-8.

8Scherk MA (Chair), et al. 2013 AAFP Feline Vaccination Advisory Panel Report. J Fel Med Surg 2013; 15:785-808.

9Wilcock B, Wilcock A, Bottoms K. Brief communication. Feline postvaccinal sarcoma: 20 years later. Can Vet J 2012; 53: 430-434.

10Dodds WJ.  Efficacy of a half-dose canine parvovirus and distemper vaccine in small adult dogs: a pilot study.    J Am Hol Vet Med Assoc  2015; 41:12-21.

11Dodds WJ, Larson LJ, Christin, KL, Schultz RD. Duration of immunity after rabies vaccination in dogs: The Rabies Challenge Fund research study. Can J Vet Res 2020; 84:153–158.

The benefits of virgin olive oil for dogs

A look at the benefits of virgin olive oil and how it can be used to support the health of your canine patients. 

Organic virgin olive oil is filled with essential beneficial ingredients that can benefit animals. Daily administration of pure cold-pressed virgin olive oil may benefit an animal’s cardiovascular system by serving as a healthy dietary fat.1 It contains over 100 diverse proteins that also serve to protect the cardiovascular system. A wealthy source of omega-3-fatty acids, virgin olive oil can provide moisture to help promote a shiny coat. It also helps preserve the softness of the skin and prevent faking, especially in the dry, winter months.5,6

Another valuable attribute of virgin olive oil is its capacity to boost plasma levels of high-density lipoproteins and reduce levels of low-density lipoproteins which can lead to a buildup of plaque in the arteries.3 Increasing the levels of high-density lipoproteins also protects animals from oxidative stress and prevents blood from clotting or blocking arterial pathways.3 Administering olive oil to dogs as part of their diet can alter their fatty acid profile to increase the levels of oleic acid and di-homo-gamma-linolenic acid – an essential nutrient that the body does not produce on its own.4

Sourcing and dosing considerations

Virgin olive oil is full of phenolic compounds due to the miniscule refinement process of cold-pressing olives.1 Cold-pressing breaks up the whole olive into little pieces and naturally separates the oil from the olives without the use of heat, which can strip vital nutrients.1

Virgin olive oil is less acidic than olive oil which makes it easier to digest.6 Due to a shorter refinement process, virgin olive oil also contains a larger antioxidant profile than olive oil, which increases its ability to combat free radical damage.1,6 Some companies may choose to use the cold pressing method and then add additional oils such as palm oil to decrease the cost of production. However, the growth and production of palm oil comes with an expensive price tag on the environment through deforestation and eradication of endangered animal’s homes.2

Virgin olive oil is safe for dogs to consume over extended periods of time as long as appropriate dosing is applied.3

Organic virgin olive oil & HempMy Pet™

HempMy Pet™ intentionally chooses to use certified organic, sustainably-sourced pure cold-pressed virgin olive oil, meaning that no other oil is added to the product that may dilute its purity. The company utilizes certified organic virgin olive oil as a carrier oil  in their 5,000 mg full-spectrum hemp-infused virgin olive oil product.  When a hemp extract is “full spectrum”, it means that the entire cannabis plant is utilized including the flower, leaves, stem, and sprouts to create a synergistic effect on the body known as the entourage effect.8

HempMy Pet™ goes the extra mile to obtain a certification of analysis for their organic virgin olive carrier oil, so customers know exactly where the oil originates from. Each batch is third party analyzed and tested to ensure purity, potency and safety for every pet.

HempMy Pet™’s certified organic virgin olive oil can be utilized for horses or as a more affordable option for a multi-dog household. The equine formula comes with an easy-to-use pump top that dispenses .5 cc per pump (approximately 20 mg). Pet parents can offer it to their animals by adding it to their food, or by encouraging them to lick it directly off their hands. The full-spectrum formula can be used on an everyday basis to promote emotional care and wellbeing, or during periods of heightened stress or anxiousness.

References

1Covas, M. I., de la Torre, R., & Fitó, M. (2015). Virgin olive oil: a key food for cardiovascular risk protection. The British journal of nutrition113 Suppl 2, S19–S28. https://doi.org/10.1017/S0007114515000136

2Vijay, V., Pimm, S. L., Jenkins, C. N., & Smith, S. J. (2016). The Impacts of Oil Palm on Recent Deforestation and Biodiversity Loss. PloS one11(7), e0159668. https://doi.org/10.1371/journal.pone.0159668

3Pedret, A., Catalán, Ú., Fernández-Castillejo, S., Farràs, M., Valls, R. M., Rubió, L., Canela, N., Aragonés, G., Romeu, M., Castañer, O., de la Torre, R., Covas, M. I., Fitó, M., Motilva, M. J., & Solà, R. (2015). Impact of Virgin Olive Oil and Phenol-Enriched Virgin Olive Oils on the HDL Proteome in Hypercholesterolemic Subjects: A Double Blind, Randomized, Controlled, Cross-Over Clinical Trial (VOHF Study). PloS one10(6), e0129160. https://doi.org/10.1371/journal.pone.0129160

4Campbell, K. L., & Dorn, G. P. (1992). Effects of oral sunflower oil and olive oil on serum and cutaneous fatty acid concentrations in dogs. Research in veterinary science53(2), 172–178. https://doi.org/10.1016/0034-5288(92)90106-c

5Tumola, C. (2018, June 14). How Can Olive Oil Benefit My Pet? Retrieved November 05, 2020, from https://www.oliveoiltimes.com/world/how-can-olive-oil-benefit-my-pet/63457

6Sailer, C. (2019, May 13). Can My Dog Eat Olive Oil? 4 Reasons to Add Olive Oil to Your Dog’s Diet. Retrieved November 05, 2020, from https://www.rover.com/blog/can-dog-eat-olive-oil/

7Vigil, J. M., Montera, M. A., Pentkowski, N. S., Diviant, J. P., Orozco, J., Ortiz, A. L., Rael, L. J., & Westlund, K. N. (2020). The Therapeutic Effectiveness of Full Spectrum Hemp Oil Using a Chronic Neuropathic Pain Model. Life (Basel, Switzerland)10(5), 69. https://doi.org/10.3390/life10050069

8Terpenes and the “Entourage Effect”. (n.d.). Retrieved November 05, 2020, from https://www.projectcbd.org/science/terpenes-and-entourage-effect

Theralase® has everything you need in a therapeutic laser

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Cutting-edge technology, fast and effective healing, and an affordable price point makes Theralase® an ideal choice for veterinarians.

In the late 1960s, in the era of Martians and ray guns, laser therapy was touted as a futuristic treatment that was just beginning to make its way into mainstream medicine. Surgical lasers made their debut first, since it was easier to witness their effects on tissue; however, therapeutic lasers came soon after, as further research demonstrated their healing effects. Therapeutic lasers soon attracted the attention of healthcare practitioners, but options were limited, as few companies had the knowhow on how to develop high quality products at affordable price points.

Laser therapy made accessible

In 1994, Theralase® came onto the scene, dedicated to designing, manufacturing, and distributing high quality, cutting-edge therapeutic laser systems at an affordable price. Their Cool Laser Therapy (CLT) systems were embraced by healthcare practitioners, who utilized them to eliminate pain in their patients, starting with knee conditions and then advancing to reducing inflammation and accelerating tissue healing for numerous nerve, muscle, and joint conditions. Twenty-five years later, Theralase® is a leader in the CLT field and has expanded into the research and development of anti-cancer treatments. In fact, the company’s motto is “Healing at the Speed of Light®”.

In 2004, Theralase® began in-licensing, researching and developing Photo Dynamic Compounds (PDCs). PDCs are light-sensitive molecules that have the ability to localize to cancer cells, bypassing healthy cells, and when light-activated, produce destructive forms of oxygen within the cancer cells to destroy them. The PDCs induce oxidative stress within the cancer cell and hence elegantly destroy it from the inside out. Theralase® is now actively researching and developing safe and effective ways to destroy various forms of cancer.

Research and products

Theralase® executes on the company’s mandate through scientific, preclinical and clinical research in each of their two divisions – Anti-Cancer Therapy (ACT) and Medical Laser Technology (MLT). Theralase® CLT exposes tissue to laser energy at two different wavelengths, within the visible and near infrared spectrums, triggering a chain of biochemical reactions within the cells to induce tissue healing and pain reduction. Using laser diodes to deliver up to 100,000 mW of power deep into injured tissue, these systems offer a highly effective, noninvasive, and pain-free treatment alternative for a wide range of nerve, muscle, and joint conditions.

Looking to the future

Theralase®, in both the ACT and MLT divisions, plans to launch new, innovative pain and oncology solutions in 2021. They have also demonstrated that their lead PDC is able to destroy a variety of viruses, including H1N1 Influenza and Zika. Next in the research phase is whether or not it is able to destroy coronaviruses, including COVID-19. If successful through a Phase III clinical study, and with the regulatory approval of Health Canada, the Theralase® COVID-19 vaccine could be commercialized across the world. (Note: the company does not claim or profess that they have the ability to treat, cure, or prevent contraction of the COVID-19 coronavirus.)

theralase.com/companionanimal/

Maintaining patient health through cellular communication

Want to maintain pet health? Here’s why cellular communication is key.

Maintaining cellular communication is a cornerstone of health for all living things, but not one that is talked about very often. And while it may seem like obscure science, it’s actually fairly straightforward. After all, everyone understands that communication is key. There are, however, several key concepts that are important to understand, starting with the extracellular matrix.

What is the extracellular matrix and what does it do?

The extracellular matrix (ECM) is a collection of extracellular molecules secreted by cells that provides structural and biochemical support to the surrounding cells and largely determines how a tissue looks and functions.

Think of the extracellular matrix as the body’s infrastructure. The signals that come from inside our cells are like scaffolding in the form of different proteins to assemble in the extracellular matrix. These extracellular molecules provide the structural and biochemical support to the surrounding cells.

This ECM system of tight junctions and gap junctions has several important functions, including protecting, feeding, and repairing cells. However, inflammation and toxins damage the ability of cells to talk to one another.

An isolated cell — unaware of its surrounding – fails to repair and cooperate with the greater system. The role of the extracellular matrix (in addition to protecting, feeding, and repairing cells) is to provide the structure that enables cell-to-cell communication. The goal is to keep the cells working as one body.

What is redox signaling?

In any situation where there are several parts working as a whole, there needs to be good communication. Imagine a cell phone. The phone doesn’t “call” anyone; the phone is the hardware that enables the signal to be transmitted. The person dialing the phone initiates the “signal”. If there are towers to pick up the signal and boost it to the destination, the call will be received on the other end. But if there is no cell tower to receive the signal and boost it to the next tower and the next and the next, the signal dies, never reaching its intended destination.

Cellular communication is very similar in that there is a system of “hard wiring”, the fiberoptic network that makes up the extracellular matrix, and the actual “signal” which is the non-physical part of the communication network. Both parts must be working for the cells to communicate (called redox signaling) with each other to produce the right chemistries that the body needs to function optimally.

Redox molecules are molecules that have oxygen and hydrogen binding sites and have the ability to act as a signal in the body through reduction and oxidation, hence the name Red-Ox. Each bacterial species (30,000 species) creates a unique subset of carbon redox metabolites during the digestive process. So, for each species of bacteria, you may see 10–15 versions of these carbon “snowflakes”. They function as an interspecies molecular communication network that allows for coordinated cell protection, injury response, and repair.

How to integrate redox signaling into your veterinary practice

This brings us to ION*Gut Health For Pets. The active ingredient in this liquid supplement is Terrahydrite®, which comes from ancient soils. ION* works via carbon-based redox signaling to maintain tight junction integrity in the epithelial layer of the gut lining.

ION* selectively induces appropriate modulation of ROS depending on the condition of the cell, reducing mitochondrial output of ROS in healthy cells, which indicates greater efficiency in energy production, and increasing ROS in cells which need immune intervention or repair. We call this the Intelligence of Nature (ION), because rather than forcing response at the cellular level, the signaling molecules in ION* amplify the cells’ own communication pathways, resulting in appropriate adaptation to the intracellular and extracellular environment.

Visit ionbiome.com/#partner to learn more.

Nanoshell technology and laser ablation — a new treatment for mast cell disease in dogs

A look at nanoshell technology and laser ablation — a new treatment for mast cell disease in canine patients.

Mast cell tumors account for 17.8% of all canine skin tumors diagnosed.1 The majority of these tumors reside in the skin or subcutaneous tissue.2 Overall, breeds with the greatest risk of high grade mast cell tumors are the Shar-Pei, Weimaraner, and Boxer.1 Treatment commonly involves surgical excision, with the goal of obtaining microscopically tumor-free surgical margins.3 Prognosis can be poor and controversial, and depends on the tumor’s location. Certain veterinarians feel that the poor prognosis comes with diagnosis of a poorly-differentiated tumor, whereas others associate it with difficulties in performing surgery.1 Thus, the poor prognosis may be associated with the difficulty of applying an appropriate surgical procedure, and incomplete tumor resection.1 However, a new treatment involving nanoparticles and laser therapy is showing promise for better outcomes.

Nanoparticles and light laser therapy

Laser light therapy (photobiomodulation) with specific light-sensitive dyes has been used for decades to treat specific types of tumor. Nanoparticles, made from noble elements such as gold, are a new discovery, and have an increased sensitivity to visible and near-infrared light absorption as compared to conventional laser phototherapy agents.

The mechanism of action for these new particles, as they enter the body by intravenous administration, is to concentrate in tissue with altered vascular permeability, such as tumor masses. When the nanoparticles are then irradiated with laser light, electrons within them enter an excited state, releasing energy through heat production, and causing an overheating of the regional tissue, along with local cell death and destruction.

Gold nanospheres, nanorods, and nanocages are commonly-used gold nanoparticles, and all have demonstrated an increased ability to absorb visual and near infrared light. The size and shape of the particles allow for vibration and spinning excitation, which produces heat and tissue necrosis when focused laser light is applied to these areas.4

Nanotherapy – pilot study and clinical trials

Companion Animal Health is conducting clinical trials utilizing nanotherapy for several tumor types, and has completed a pilot study with small mast cell tumors. These nanoparticles are made with a gold shell and non-conducting silica core. Their average size is 150 nanometers in diameter. The particles target cancerous tissue, including low grade mast cell tumors due to alterations in the endothelium of the blood supply of these masses, and are then irradiated with focused infrared laser energy.

Photos courtesy of Olympia Veterinary Specialists: The Cancer Center and Bridge Animal Referral Center

Initial data from this study was presented at the ACVIM in 2018 and revealed that all patients responded to Companion Nanotherapy, with 67% maintaining remission. The procedure was completed as a single treatment with a very low rate of toxicity (See figures 1-8).5

Currently, more formal study groups are in progress at multiple trial sites, looking at Companion Nanotherapy’s use in oral squamous cell carcinoma (cats), oral and cutaneous melanomas (dogs), and soft tissue sarcomas (dogs). To date, this treatment modality has been used on more than 130 dogs and cats with various types of tumor. All patients have shown a very low rate of toxiciy and complications, thus far.

Given the current treatment options for low-grade cutaneous mast cell tumors, nanoshell therapy and photothermal ablation may offer patients a non-surgical, one-time treatment option with few to no complications. This treatment modality may allow veterinarians to shrink and stop tumor growth in patients that have masses in regions where surgery may not be as successful, and where limited surgical margins may affect prognosis.

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1Śmiech A , Ślaska B, Łopuszyński W, Jasik A, Bochyńska, D, Dąbrowski, R. “Epidemiological assessment of the risk of canine mast cell tumors based on the Kiupel two‑grade malignancy classification”. Acta Vet Scand (2018) 60:70.

2Thompson JJ, Pearl DL, Yager JA, Best SJ, Coomber BL, Foster RA. “Canine Subcutaneous Mast Cell Tumor: Characterization and Prognostic Indices”. Veterinary Pathology 48(1) 156-168.

3Milovancev M, Townsend KL, Tuohy JL, et al. “Long-term outcomes of dogs undergoing surgical resection of mast cell tumors and soft tissue sarcomas: A prospective 2-year-long study”. 2019 The American College of Veterinary Surgeons, Veterinary Surgery. 2020;49:96–105.

4Huang X, Jain PK, El-Sayed IH, El-Sayed MA. “Plasmonic photothermal therapy (PPTT) using gold nanoparticles”. Lasers Med Sci (2008) 23:217–228.

5Parshley L. “Nanoparticle and laser thermal ablation in canine low-grade mast cell tumor”.  Proceedings, ACVIM Forum, 2018. Olympia Veterinary Cancer Center, Olympia, WA, 2020.